Long-term effects of HIV counseling and testing for women: Behavioral and psychological consequences are limited at 18 months posttest.

Behavioral and psychological consequences of HIV counseling and testing (HIV C&T) for women were examined in a longitudinal, prospective study. Women who received HIV C&T at community health clinics (n?=?106) and a comparison group of never-tested women (n?=?54) were interviewed five times over 18 months. There was no change in risk behaviors as a consequence of testing: tested and untested women engaged in high-risk sexual behavior at baseline and 18 months later. Tested women reported more anxiety, depression, and intrusive thoughts about AIDS than did untested women. Although tested women were more concerned about AIDS, their potential risk factors over the study period generally were equivalent to those for untested women. HIV counseling and testing should be considered one aspect of a broader program of HIV prevention. Identification of alternative interventions must be a public health priority. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral and psychological responses to HIV antibody testing.

The development of tests to identify the antibody to human immunodeficiency virus (HIV) has made it possible to diagnose infection with the virus prior to the development of physical symptoms. The introduction of these tests raises questions regarding the effects of informing individuals that they have been infected with a fatal virus and the usefulness of antibody testing in promoting behaviors that would reduce the spread of acquired immunodeficiency syndrome (AIDS). Research that has examined changes in psychological distress and in behaviors associated with HIV infection among individuals who have undergone antibody testing is reviewed. Methodological issues encountered in studying behavioral and psychological responses to antibody testing are identified, and directions for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal psychosocial factors associated with substance use in Mexican-origin and African American low-income pregnant women

PURPOSE: To describe ethnic-specific patterns of substance use before and during pregnancy in low-income pregnant women, examine the associations between psychosocial factors and patterns of substance use within ethnic groups, and assess maternal sociodemographic, prenatal, and psychosocial factors of women who continue to use substances during pregnancy and those who do not. METHOD: A prospective study of low-income, primiparous African American (n = 255), Mexican American (n = 525), and Mexican immigrant (n = 764) women was conducted in 22 prenatal care clinics in Los Angeles, CA. Data were collected in face-to-face interviews in both English and Spanish on prenatal life events, anxiety, sources of support, and substance use behaviors three months before and during pregnancy. FINDINGS: Significant ethnic differences were found in use of alcohol, cigarettes, and illicit drugs. African American women were more likely than Mexican-origin women to report use of substances before and during pregnancy. Mexican American women were more likely than Mexican immigrant women to report use of substances before and during pregnancy. Women who continued to use substances during pregnancy were less likely to be living with the baby's father, to have planned the pregnancy, to report having been able to go for prenatal care as soon as they wanted, and more likely to be identified at medical risk. CONCLUSIONS: Providers must increase the assessment and monitoring of substance use behaviors of low-income women in prenatal care settings. The role of health care providers must encompass advocacy and public health education.     

The efficacy of Structural Ecosystems Therapy for HIV medication adherence with African American women.

A systemic family therapy intervention, Structural Ecosystems Therapy (SET; Mitrani, Szapocznik, & Robinson-Batista, 2000; Szapocznik et al., 2004), has been shown to promote adaptation to living with HIV by reducing psychological distress and family hassles. This investigation examines the effect of SET on HIV medication adherence relative to a person-centered condition and a community control condition. Medication adherence was assessed on 156 trial participants. Results of a 2-part model showed that SET was significantly more likely to move women to high levels of adherence (defined as at least 95% adherence) than a person-centered therapy. Family hassles were also significantly reduced by SET, though the effect of SET on medication adherence did not appear related to this change in family hassles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women who have sex with other women: HIV seroprevalence in New York State counseling and testing programs

This report provides HIV seroprevalence data for women who are sexually active with women (WSW) choosing to access services in four of New York State's counseling and testing programs from January 1993 to June 1994. During that period, these programs tested 27,370 women. When questioned about sexual activity since 1978, 3.7% of these women reported sexual activity exclusively with women, 5.3% reported sexual activity with both women and men and 90.1% reported sexual activity exclusively with men. HIV seroprevalence in women sexually active exclusively with women in this sample was calculated at 3.0%, at 4.8% in women sexually active with both women and men and at 2.9% in women sexually active exclusively with men. According to the self-reported data in this study, injecting drug use is, by far, the predominant risk factor for seropositive WSW. Significant HIV-related public health/preventative implications for WSW and their service providers are suggested by this data, including the need for prevention education targeted to WSW who are IDUs, the need to provide culturally sensitive education to WSW detailing safer sexual behaviors both with women and with men as well as the need for evaluation of all risk factors when providing risk reduction education to WSW.     

Effect of HIV reporting by name on use of HIV testing in publicly funded counseling and testing programs

CONTEXT: Policies requiring confidential reporting by name to state health departments of persons infected with the human immunodeficiency virus (HIV) have potential to cause some of them to avoid HIV testing. OBJECTIVE: To describe trends in use of HIV testing services at publicly funded HIV counseling and testing sites before and after the implementation of HIV reporting policies. DESIGN AND SETTING: Analysis of service provision data from 6 state health departments (Louisiana, Michigan, Nebraska, Nevada, New Jersey, and Tennessee) 12 months before and 12 months after HIV reporting was introduced. MAIN OUTCOME MEASURE: Percent change in numbers of persons tested at publicly funded HIV counseling and testing sites after implementation of confidential HIV reporting by risk group. RESULTS: No significant declines in the total number of HIV tests provided at counseling and testing sites in the months immediately after implementation of HIV reporting occurred in any state, other than those expected from trends present before HIV reporting. Increases occurred in Nebraska (15.8%), Nevada (48.4%), New Jersey (21.3%), and Tennessee (62.8%). Predicted decreases occurred in Louisiana (10.5%) and Michigan (2.0%). In all areas, testing of at-risk heterosexuals increased in the year after HIV reporting was implemented (Louisiana, 10.5%; Michigan, 225.1 %; Nebraska, 5.7%; Nevada, 303.3%; New Jersey, 462.9%; Tennessee, 603.8%). Declines in testing occurred among men who have sex with men in Louisiana (4.3%) and Tennessee (4.1%) after HIV reporting; testing increased for this group in Michigan (5.3%), Nebraska (19.6%), Nevada (12.5%), and New Jersey (22.4%). Among injection drug users, testing declined in Louisiana (15%), Michigan (34.3%), and New Jersey (0.6%) and increased in Nebraska (1.7%), Nevada (18.9%), and Tennessee (16.6%). CONCLUSIONS: Confidential HIV reporting by name did not appear to affect use of HIV testing in publicly funded counseling and testing programs.     

Antenatal HIV antibody testing in Australia

OBJECTIVE: To evaluate the role of voluntary antenatal testing in HIV surveillance and prevention by examining antenatal HIV antibody testing practice and policy in Australia. DESIGN: Cross-sectional study using a self-administered questionnaire. SUBJECTS AND SETTING: Specialist obstetricians and gynaecologists and general practitioners (GPs) affiliated with the Royal Australian College of Obstetricians and Gynaecologists and Australian public hospital antenatal clinics, August-November 1992. MAIN OUTCOME MEASURES: The percentage of public hospital antenatal clinics and specialist and GP obstetricians in Australia who tested pregnant women for HIV antibody as part of their antenatal care, and the proportion of pregnant women in Australia who had an antenatal HIV antibody test in the 1991-92 financial year. RESULTS: Questionnaires concerning antenatal HIV antibody testing were completed by 90% (993/1108) of specialists, 87% (2134/2461) of GPs and 93% (215/230) of public hospitals surveyed. Of the 706 specialists and 1503 GPs who reported that they were currently engaged in obstetric care, approximately 60% (430/706) and 935/1503, respectively) offered antenatal HIV testing either to all pregnant women or to selected groups at risk. There were significant differences in testing patterns between States and Territories. For the 95 public hospitals with antenatal clinics, 81% (77) offered the HIV antibody test to all or selected groups of pregnant women; these percentages did not differ significantly between States and Territories. It was estimated that 25% of pregnant women seen by specialists, 29% seen by GPs and 9% seen in public hospital clinics were tested for HIV antibody as part of their antenatal care in 1991-92. CONCLUSIONS: In Australia approximately one in five pregnant women were tested for HIV antibody as part of their antenatal care in 1991-92. Voluntary HIV testing in pregnancy may provide unrepresentative data for measuring the prevalence of HIV infection in pregnant women.     

Emergency department-based HIV screening and counseling: experience with rapid and standard serologic testing

OBJECTIVE: To examine the feasibility of conducting a reverse record-check study to validate parent reporting on child mental health service use and to examine the accuracy of parent reports of child mental health services. METHOD: Information about child service use was abstracted from medical records and subsequently compared with reports provided by caregivers in telephone interviews. A sample of children using outpatient psychiatric services was compared with a sample of children using outpatient orthopaedic services. Rates and correlates of successful caregiver tracking and of service use reporting accuracy were explored. RESULTS: Caregivers of nearly 30% of all index children were contacted and interviewed. Parent reports of lifetime mental health service use were more accurate than reports of lifetime receipt of orthopaedic services. Elapsed time between survey interview and last treatment episode was negatively associated with reporting accuracy. Number of clinic visits was positively associated with reporting accuracy. Preliminary findings suggested that questions about mental health services may be considered sensitive by parents whose children use them. CONCLUSIONS: Reverse record-check studies based on telephone interviews are potentially problematic with a sample drawn from a large, inner-city medical center. Findings suggest that memory difficulties may be a more important correlate of reporting accuracy than response editing (social desirability). Potential discomfort with disclosure of mental health service use does not result in service use underreporting.     

Preventive health practices of African American women

Preventive health practices of African American women (AAW) have been little studied. This study explores the participation of middle-income AAW in health promotion/disease prevention behavior. In-depth, audiotape, and semi-structured interviews were held with 36 AAW between the ages of 26 and 75 years. Results indicated that the majority of the women participated in diet control behavior for health purposes. Participation in weight management and exercise behavior was less extensive. The women were involved in other types of preventive health practices to keep healthy. The findings reveal the need for increased educational efforts in the areas of weight management, exercise behavior, mammography, and in the practice of breast self-examination. Results of the study have implications for researchers, educators, and clinicians.     

HIV antibody testing in the antenatal clinic

It is "standard" to analyze data from a clinical trial using a narrowly defined probabilistic mathematical model. This paper examines the ways in which mathematical models, in general, can be used in clinical research, the meaning of probability in the examination of clinical trials, and the philosophical flaws in the current "standard" method. An alternative formulation is proposed which is more flexible and which comes closer to meeting the needs of medical science. In this alternative formulation, significance tests are applied to the data from a study only as a first step to determine whether the data are worth further examination. After that, clinically relevant questions are answered with 50 and 95% confidence bounds. The initial significance test is tailored to be directed at a narrow class of hypotheses that, in turn, are dictated by clinical expectations.     

Racial microaggressions against African American clients in cross-racial counseling relationships.

This study examined the relationships among African American clients' perceptions of their White counselors with respect to (a) perceived racial microaggressions in cross-racial counseling relationships, (b) the counseling working alliance, (c) their counselors' general and multicultural counseling competence, and (d) their counseling satisfaction. Findings revealed that greater perceived racial microaggressions by African American clients were predictive of a weaker therapeutic alliance with White therapists, which, in turn, predicted lower ratings of general and multicultural counseling competence. Greater perceived racial microaggressions also were predictive of lower counseling satisfaction ratings. In addition, African American clients' perceptions of racial microaggressions had a significant indirect effect on these clients' ratings of White counselors' general and multicultural counseling competence through the therapeutic working alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV risk behaviors among inner-city African American women. The Community Housing AIDS Prevention Study Group

This study examined the prevalence and predictors of HIV risk behaviors among a sample of 875 low-income, African American women residents of inner-city housing developments. The women completed an anonymous questionnaire that revealed that one third of them were at high risk for HIV either because they had multiple partners or because of the high-risk behaviors of their regular partner. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, reported weak behavioral intentions to reduce risk, and held stronger beliefs about psychosocial barriers to condom use. Women at high risk were also younger, reported higher rates of substance use, and indicated that their housing development lacked social cohesiveness. These findings suggest that HIV prevention efforts for this population should focus on strengthening women's risk reduction behavioral intentions and self-efficacy through skill development, overcoming psychosocial barriers to condom use, managing the risk related to substance use, and incorporating approaches that take into account the social, psychological, and relationship barriers to change among economically impoverished African American women.     

Anger of African American women in the south

In this existential-phenomenological investigation middle-class African American women (n = 9) in the Southern United States were interviewed about their experience of anger in daily life. The purpose of the study was to examine what African American women's anger is about, what it means, and how it is experienced. Transcribed interviews were analyzed using a hermeneutic process. The thematic structure of African American women's anger comprises three main elements that stand out as figural: power, control, and respect. These figural elements can be understood only when seen against the ground of a racist Southern culture that produces pervasive mistrust. These findings are of importance to clinicians, who cannot deliver culturally competent interventions to African American female clients without a clear understanding of the complexity and meaning of their anger experience.     

Staging of dietary patterns among African American women

This article describes the development of a behavioral staging algorithm for use in the Eat Well, Live Well Nutrition Program, a peer-delivered community-based program for African American women (N = 301). The authors examined whether increased frequency in performing low-fat eating behaviors and lower percentage calories from fat intake resulted as a participant moved through five stages of readiness to change each of five low-fat dietary patterns. Frequency of performing low-fat dietary behaviors was significantly different (p<.05) between four stages for the pattern of avoid fried foods, three stages for modify meats, and two stages for the patterns of substitution, avoid fat as seasoning, replacement. Percentage calories from fat were significantly different (p<.05) between four stages for the pattern of replacement, three stages for avoid fried foods and modify meats, and two stages for substitution and avoid fat as seasoning. Implications of these findings for the tailoring of community-based dietary programs are presented.     

Predicting mammography and breast self-examination in African American women

In the past ten years four sportsmen with a traumatic perilymphatic fistula were treated. Three of these four patients were surgically treated: two of them underwent a labyrinthectomy and with one of them, the oval window was grafted. After the analysis of these cases, we have made a study of the literature. Careful attention to the patient history and accurate review of the recurrent vestibulocochlear symptomatology isolate a clinical "audiovestibular syndrome of perilymphatic fistule". There is lack of precise preoperatoire diagnostic test. Nevertheless, entire positionnal audiometric test is a reliable and easy to perform test. The medical management is based on bed rest during a reasonable period. Only patients with significant suggestive symptomatology are surgically explored . They sometimes need destruction of vestibular function without preservation of hearing.     

Anonymous testing of HIV infection in pregnant women

To investigate the contribution of nigral degeneration to the development of parkinsonism in the early stages of corticobasal degeneration (CBD), we measured the cerebrospinal fluid (CSF) levels of homovanillic acid (HVA) in patients with early CBD (n = 5), and compared the levels with those in patients with early Parkinson's disease (n = 11) and in normal subjects (n = 13). The mean CSF HVA level in the early CBD group (33.1 +/- 6.0 ng/ml) did not differ significantly from that in the control group (37.1 +/- 12.7 ng/ml), whereas that in the early Parkinson's disease group (19.0 +/- 7.6 ng/ml) was reduced significantly (P < 0.001). This result suggests that neuronal cell loss in the substantia nigra and presynaptic nigrostriatal dopaminergic neuron dysfunction are mild in the early stages of CBD.     

Prevalence of eating disorders among African American women.

This study was the first to establish Diagnostic and Statistical Manual of Mental Disorders (DSM—IV; American Psychiatric Association, 1994) prevalence rates for eating disorders by targeting an entire sample of African American college women. Participants were 413 African American women enrolled at a large, predominantly Caucasian public university in the midwestern United States. Participants were given the Questionnaire for Eating Disorder Diagnoses (L. B. Mintz, M. S. O'Halloran, A. M. Mulholland, & P. A. Schneider, 1997). No respondents were classified as having anorexia nervosa or bulimia nervosa, and 2% were classified as having an eating disorder not otherwise specified. Twenty-three percent were classified as symptomatic. Although there is some evidence that these prevalence rates may be underestimated, they are nevertheless in the same range as those obtained for comparative Caucasian samples. Implications for future research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)